Epidemiology of community-treated and hospitalized Clostridioides difficile infection and estimation of attributable hospitalization costs in France, 2015-2019.

BACKGROUND

While the incidence of Clostridioides difficile infection (CDI) is well characterized within the hospital setting, its burden in the community remains largely unknown. We aimed to characterize the epidemiology of community-treated and hospitalized CDI in the adult population, and to estimate the costs attributable to CDI-related hospitalizations in France between 2015 and 2019.

METHODS

This retrospective cohort study used the French administrative healthcare database and a dedicated algorithm to identify and classify CDI episodes based on treatment location (community-treated or hospitalized), estimate population-based incidence rates, determine the probable origin of infection (community-vs. healthcare-associated), and evaluate mortality and hospitalization costs.

RESULTS

The average CDI incidence rate was 61.4 episodes/100,000 population/year, with approximately half of CDIs treated in the community. Rates of community-treated CDI rose by 17% over the study period, whereas those of hospitalized CDI declined by 9%. Most (79%) community-treated CDIs were community-associated, while most (83%) hospitalized CDI episodes were healthcare-associated. The incidence rate of CDI episodes increased with age, from 25 to 69 per 100,000 population for community-treated episodes and 7 to 192 per 100,000 population for hospitalized episodes, in patients aged 18-49 and ≥ 85 years, respectively. The 12-month mortality rate was 5.2% for community-treated patients and 20% for hospitalized patients post-discharge. The average annual cost of hospitalized CDI was €189 million.

CONCLUSION

In France, CDIs are no longer confined to hospitals, with an equal burden in the community. These findings support the need for strengthening prevention efforts, promoting diagnostic and improving management strategies across healthcare settings.